Topical and Systemic Therapies for Nickel Allergy

Antonella Tammaro; Alessandra Narcisi; Severino Persechino; Cristiano Caperchi; Anthony Gaspari

Disclosures

Dermatitis. 2011;22(05):251-255. 

In This Article

Hyposensitization With Nickel

The concept of immunomodulation, developed in the 1990s, is as follows: the induction of tolerance to a specific antigen may be obtained by a mechanism of active suppression or by the induction of a clonal allergy.[25] The experiments of Bagot and colleagues, carried out in a double-blind-versus-placebo study, clearly demonstrated that oral nickel administration in humans may importantly reduce the number of circulating T-cell lymphocytes activated against this antigen.[26] In 1992, Van Hoogstraten and colleagues demonstrated that complete tolerance can be maintained for 2 years as long as oral contact with the allergen is avoided. Oral administration of nickel could induce an immune-specific tolerance by a clonal expansion of subtypes of CD4+ T-cell clones, T-regulatory cells, with suppressing activity that limits tissue damage and inflammatory-response T-regulator cells.[27,28]

The first oral hyposensitization therapy was experimented with by van Hoogstraten and colleagues with the administration of nontoxic nickel doses to sensitized mice for 1 to 3 weeks.[27,28] However, the first successful result with humans was obtained in 1987 by Sjovall, who observed less-intense reactions to patch tests after he administered oral capsules containing different nickel concentrations to a selected patient group for 6 weeks.[29]

In 2009, our group performed a clinical trial of oral hyposensitization therapy with low doses of nickel in 67 patients affected by systemic allergy to this sensitizer. All patients reported a significant benefit in regard to both cutaneous and systemic symptoms, with the reduction or absence of itching and partial or complete clearing of ACD after the first 4 weeks of treatment. In fact, 70% of the patients completed the increasing phase (10 weeks) and the maintaining phase with the following results after the reintroduction of a nickel-free diet: 67% reported a complete remission of symptoms; in 23%, a clinical improvement was noted, with the rare appearance of cutaneous or digestive symptoms of lower intensity; and three patients also reported a reduction in weight. Adverse reactions were observed only in 18 patients: 12 patients with primary cutaneous dermatitis reported mild itching, and 6 patients with gastrointestinal manifestations reported digestive disorders of low intensity.[4]

This systemic therapy led to favorable results both in regard to cutaneous symptoms and in regard to gastrointestinal histologic modifications induced by nickel allergy, in contrast to all other therapies that could only act on the dermatitis.[4,30–32]

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